﻿<!DOCTYPE html>
<html xmlns="http://www.w3.org/1999/xhtml">
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    <title></title>
    <link href="Style.css" rel="stylesheet" />
</head>
<body>
    <div>
        <h2>Personuppgifter - Ansökan om borglig vigsel</h2>
        <fieldset id="myform">
            <legend>Contact form example</legend>
                <div>
                    <label for="Personnummer">Personnummer</label>    
                    <input id="Personnummer" data-bind="value: Wedding.Person.ID" type="text" placeholder="PersonnummerPlaceholder" name="Personnummer" title="Phone  is requiered" />
                </div>
                <div>
                    <label for="Förnamn">Förnamn</label>    
                    <input id="Förnamn" data-bind="value: Wedding.Person.FirstName" type="url" placeholder="FörnamnPlaceholder" name="Förnamn" title="Förnamn  requiered" />
                </div>
                <div>
                    <label for="Efternamn">Efternamn</label>    
                    <input id="Efternamn" data-bind="value: Wedding.Person.LastName" type="text" placeholder="LastNamePlaceholder" name="LastName" title="LastName  is requiered"" />
                </div>
                            <div>
                    <label for="Telefonnummer">Telefonnummer</label>    
                    <input id="Telefonnummer" data-bind="value: Wedding.Person.PhoneNumber" type="text" placeholder="TelefonnummerPlaceholder" name="Telefonnummer" title="Telefonnummer  is requiered"" />
                </div>
                <div>
                    <label for="Mobiltelefon">Mobiltelefon</label>    
                    <input id="Mobiltelefon" data-bind="value: Wedding.Person.CellularNumber" type="text" placeholder="MobiltelefonPlaceholder" name="Mobiltelefon" title="Mobiltelefon  is requiered"" />
                </div>
                <div>
                    <label for="Gatuadress">Gatuadress</label>    
                    <input id="Gatuadress" data-bind="value: Wedding.Person.Adress" type="text" placeholder="GatuadressPlaceholder" name="Gatuadress" title="Gatuadress  is requiered"" />
                </div>
                <div>
                    <label for="E-post">E-post</label>    
                    <input id="E-post" data-bind="value: Wedding.Person.Email" type="text" placeholder="E-postPlaceholder" name="E-post" title="E-post  is requiered"" />
                </div>
                <div>
                    <label for="Postort">Postort</label>    
                    <input id="Postort" data-bind="value: Wedding.Person.District" type="text" placeholder="PostortPlaceholder" name="Postort" title="Postort  is requiered"" />
                </div>
                <div>
                    <label for="Postnummer">Postnummer</label>    
                    <input id="Postnummer" data-bind="value: Wedding.Person.Zip" type="text" placeholder="PostnummerPlaceholder" name="Postnummer" title="Postnummer  is requiered"" />
                </div>
        </fieldset>
        <fieldset id="Övrigt">
            <legend>Övrigt</legend>
                <div>
                    <label for="Postnummer">Diarienummer på ansökt Hindersprövning</label>    
                    <input id="Text1" data-bind="value: Wedding.Other.HindersprövningDnr" type="text" placeholder="PostnummerPlaceholder" name="Postnummer" title="Postnummer  is requiered"" />
                </div>
                <div>
                    <label for="FeedbackType">Jag önskar återkoppling, via</label>
                    <select id="FeedbackType" data-bind="value: Wedding.FeedbackType">
                        <option>Välj...</option>
                        <option>Mina sidor</option>
                        <option>E-post</option>
                        <option>Brev</option>
                    </select>   
                </div>
        </fieldset>
    </div>
</body>
</html>
